Resurfacing with full-thickness skin graft after debulking procedure for bulky flap of the hand

Background: A bulky flap on the hand can hamper its range of motion and result to unacceptable cosmoses and poor functions. Conventional debulking procedures cannot provide a one-stage adequate debulking of the hand after free-flap reconstruction. Methods: From January 2004 to December 2005,12 debulking procedures were performed on 12 hands of 12 patients who had received reconstruction with free anterolateral thigh fasciocutaneous flaps for skin defect of the hands. The epidermis and most of the dermis were harvested from the flap, regrafted on the defatted wound and fixed with tie-over dressing for 7 days. The two-point discrimination and hair growth were assessed after 6 months during follow-up of each case. Results: The mean follow-up time was 6 months. The areas of nap size ranged from 5 x 3 cm to 15 x 5 cm. All the grafted skin took well except in 2 cases, which had small areas of superficial skin loss. The mean time frame of debulking procedure after primary reconstruction was 2.6 +/- 1.4 months (range, 0.6-5 months). The average thickness of removed fat was 8.3 +/- 2.6 mm (n = 12). The two-point discrimination test result of injured hands before and after debulking procedures were unmeasured and 13.1 +/- 1.4 mm (n = 12), respectively. The hair growth in the debulked areas was less than the original donor sites. The difference in hair growth of flaps before and after debulking procedures was statistically significant (p < 0.005). Conclusion: This method can provide strict thin skin coverage for the hand after free flap reconstruction to achieve good functional and esthetic requirements.